1659600815 NPI number — CAH ACQUISITION COMPANY 4 INC

Table of content: (NPI 1659600815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659600815 NPI number — CAH ACQUISITION COMPANY 4 INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAH ACQUISITION COMPANY 4 INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659600815
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 W BYPASS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DRUMRIGHT
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74030-5957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-382-2300
Provider Business Mailing Address Fax Number:
918-382-2391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
612 W. BYPASS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRUMRIGHT
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-382-5955
Provider Business Practice Location Address Fax Number:
918-382-4709
Provider Enumeration Date:
12/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CAPSHEW
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
918-382-2300

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  2367 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200259440D , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com